Surgical Modality as a Determinant of Survival and Neurological Outcome Following the Evacuation of Acute Subdural Hematomas
Keywords:Traumatic acute subdural hematoma, preoperative clinical status
Objective: We designed the present study to compare the clinical outcomes of the craniotomy and the decompressive craniectomy procedures that we had performed in our department for evacuating traumatic acute subdural hematomas.
Material and Methods: We retrospectively analyzed the medical data of all the adult patients in whom a craniotomy or a decompressive craniectomy had been performed for evacuating acute traumatic subdural hematoma. The demographic data, the preoperative Glasgow Coma Scale (GCS), and the clinical outcome were studied.
Results: A craniotomy had been carried out in five patients for traumatic AcSDH evacuation while in twelve patients a decompressive craniectomy had been performed. The mean preoperative GCS was 9 in the patients that underwent a craniotomy, whereas the mean preoperative GCS in the decompressive craniectomy group was 6.8. The overall mortality was 47%. In the craniotomy group, 4 (80%) patients survived and 1 (20%) patient expired. In the decompressive craniectomy group, 5 (41.7%) patients survived and 7 (58.3%) patients expired. The outcome in all the 9 surviving patients was favorable based on the Glasgow Outcome scale and all of them were independent of follow-up.
Conclusion: Better clinical outcome was observed in patients who had undergone a craniotomy compared to those in whom a decompressive craniectomy had been performed. Patients that underwent a craniotomy were also in a better clinical status preoperatively compared to patients who underwent a decompressive craniectomy.
Fountain DM, Kolias AG, Lecky FE, Bouamra O, Lawrence T, Adams H, et al. Survival Trends after Surgery for Acute Subdural Hematoma in Adults Over a 20-year Period. Ann Surg. 2017; 265 (3): 590–596.
Rush B, Rousseau J, Sekhon MS, Griesdale DE. Craniotomy Versus Craniectomy for Acute Traumatic Subdural Hematoma in the United States: A National Retrospective Cohort Analysis. World Neurosurg. 2016; 88: 25-31.
Monsivais D, Huimahn A Choi, Ryan Kitagawa, Franch M, Cai C. A retrospective analysis of surgical outcomes for acute subdural hematoma in an elderly cohort. Interdiscip Neurosurg. 2018; 14: 130–134.
Lavrador JP, Teixeira JC, Oliveira E, Simao D, Santos MM, Simas N. Acute Subdural Hematoma Evacuation: Predictive Factors of Outcome. Asian J Neurosurg. 2018; 13 (3): 565–571.
Lee D, Song SW, Choe WJ, Cho J, Moon CT, Koh YC. Risk Stratification in Patients with Severe Traumatic Acute Subdural Hematoma. Nerve. 2017; 3 (2): 50–57.
Pinggera D, Bauer M, Unterhofer M, Thomé C, Unterhofer C. Craniotomy size for traumatic acute subdural hematomas in elderly patients-same procedure for every age? Neurosurg Rev. 2022; 45 (1): 459-465.
Kwon YS, Yang KH, Lee YH. Craniotomy or Decompressive Craniectomy for Acute Subdural Hematomas: Surgical Selection and Clinical Outcome. Korean J Neurotrauma. 2016; 12 (1): 22-7.
Ahmed N, Greenberg P, Shin S. Mortality Outcome of Emergency Decompressive Craniectomy and Craniotomy in the Management of Acute Subdural Hematoma: A National Data Analysis. The American Surgeon, 2021; 87 (3): 347-353.
Chen SH, Chen Y, Fang WK, et al. Comparison of craniotomy and decompressive craniectomy in severely head-injured patients with acute subdural hematoma. The Journal of Trauma. 2011; 71 (6): 1632-1636.
Kalayci M, Aktunç E, Gül S, Hanci V, Edebali N, Cagavi F, Açikgöz B. Decompressive craniectomy for acute subdural haematoma: an overview of current prognostic factors and a discussion about some novel prognostic parametres. J Pak Med Assoc. 2013 Jan; 63 (1): 38-49.
Ruggeri AG, Cappelletti M, Tempestilli M, Fazzolari B, Delfini R. Surgical management of acute subdural hematoma: a comparison between decompressive craniectomy and craniotomy on patients treated from 2010 to the present in a single center. J Neurosurg Sci. 2022; 66: 22-7.
Y?lmaz ?, Ertem DH, K?l?ç M, et al. Factors associated with mortality in acute subdural hematoma: Is decompressive craniectomy effective? Ulusal Travma ve Acil Cerrahi Dergisi = Turkish Journal of Trauma & Emergency Surgery: TJTES. 2019; 25 (2): 147-153.
Jost JN. Primary Decompressive Craniectomy after Traumatic Brain Injury: A Literature Review. Cureus. 2022; 14 (10): e29894.
Kim H, Suh SJ, Kang HJ, Lee MS, Lee YS, Lee JH, Kang DG. Predictable Values of Decompressive Craniectomy in Patients with Acute Subdural Hematoma: Comparison between Decompressive Craniectomy after Craniotomy Group and Craniotomy Only Group. Korean J Neurotrauma. 2018; 14 (1): 14-19.
Karibe H, Hayashi T, Hirano T, Kameyama M, Nakagawa A, Tominaga T. Surgical management of traumatic acute subdural hematoma in adults: a review. Neurol Med Chir (Tokyo). 2014; 54 (11): 887-94.
Kim KH. Predictors for functional recovery and mortality of surgically treated traumatic acute subdural hematomas in 256 patients. J Korean Neurosurg Soc. 2009 Mar; 45 (3): 143-50.
Phan K, Moore JM, Griessenauer C, Dmytriw AA, Scherman DB, Sheik-Ali S, Adeeb N, Ogilvy CS, Thomas A, Rosenfeld JV. Craniotomy Versus Decompressive Craniectomy for Acute Subdural Hematoma: Systematic Review and Meta-Analysis. World Neurosurg. 2017; 101: 677-685.e2.
Copyright (c) 2022 Pakistan Journal Of Neurological Surgery
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.